Universal health coverage: a right and not a privilege for all African citizens

In this post, Olushayo Olu discusses the importance of universal health coverage in Africa, a key feature of the 1st WHO Africa Health Forum held in Kigali, Rwanda, in June 2017. The meeting report of the forum has just been published in BMC Proceedings.

Universal health coverage (UHC) is a situation where every person irrespective of where they live and their socioeconomic status, have access to good quality health services without having to go through any financial hardship.

It has three key elements, namely: equity in access to healthcare in terms of geographic coverage and the range of available health services, health services which are of high quality, and financial protection against any hardship to users of health services which may be arise as a result of out-of-pocket payments.

UHC is central to the principles of the Sustainable Development Goals (SDGs) of leaving no one behind. Its benefit goes beyond ensuring good health for populations; it also contributes to reduction in poverty, gender equity, social economic growth, and human capital development of any society.

In my opinion, UHC is not a privilege but a right for all African citizens.

In my opinion, UHC is not a privilege but a right for all African citizens. However, to many people, it may appear to be an ambitious target which would be difficult to achieve by many African countries.

Of course, as a public health physician with extensive working experience in Africa, I have witnessed first-hand the challenges in attaining UHC such as inadequate human resources for health, weak medicines supply chain management systems, inadequate and unsustainable financing of health services, and recurrent disasters which weakens health systems.

The high levels of poverty; poor status of the social; economic and environmental determinants of health; and the fact that a sizable majority of African citizens work in the informal sectors, making it difficult for them to participate in social protection and health insurance schemes, further compound the problem.

Achieving universal health coverage

Despite these challenges, I do strongly believe that attainment of UHC is a feasible aspiration which should be vigorously pursued by all African countries. The lessons learnt from implementation of the Millennium Development Goals (MDGs) have shown that with strong political commitment and good governance, African countries could overcome the adversities which stand between them and UHC.

There are very good examples such as Rwanda; a country which was able to transform itself against all odds from the tragic events of 1994 to achieve all the health related MDGs. This enviable achievement was made possible by political commitment to health, good governance, accountable leadership, self-determination and use of innovations including a well acclaimed community-based health insurance program which covers more than 85% of its target population.

Similar but tailor-made methods could be used by other African countries to deploy innovative, cost-effective and context specific strategies and appropriate technologies to ensure sustainable financing of healthcare services, extension of health services to the populations which are underserved and to expand the range of health services.

The call-to-action which was the final outcome of the forum called on African political leaders and public health policy makers to increase political commitment and domestic investments in health.

It is therefore instructive that the first ever Africa Health Forum took place in Kigali Rwanda in June 2017. The forum in which I actively participated as an organizer and participant was convened to brainstorm on the key challenges and ways to fast track attainment of UHC in Africa and to galvanize commitment of African political leaders, civil society and the private sector to UHC and health SDG agenda.

The report of the forum, published in BMC Proceedings, provides insights into how UHC can be achieved in Africa. The participants and discussants at the forum proposed the use of evidence-based methods to advocate for sustainable domestic financing of health care services, institution of mandatory social protection and prepaid health insurance, and doubling of the efforts to generate good quality public health data.

The forum further identified increased private sector engagement in health services delivery and financing, strengthened partnerships, improved intersectoral collaborations and the use of south-south cooperation mechanisms as critical tools for fast tracking attainment of UHC on the continent.

The call-to-action which was the final outcome of the forum called on African political leaders and public health policy makers to increase political commitment and domestic investments in health and to fast track deployment of new technologies, including digital health solutions to support the attainment of UHC.

In conclusion, UHC should be viewed as a high yield investment which would ultimately translate into a healthier and productive population which will in turn transform Africa socioeconomically thus its attainment should not be negotiable. Looking forward, use of innovative approaches and evidence are needed to boost the attainment of UHC on the continent.

Comments

Dr Olu is a public health physician who specialised in management of infectious diseases. He has over 27 years professional experience working as a public health specialist with several organizations in Africa and Asia including the Ministry of Health of Nigeria, Medecin San Frontieres (MSF) and the World Health Organization. His work and research interests are in global health, health system strengthening, public health disaster risk management, and infectious diseases epidemiology. He recently co-hosted the first Africa Health Forum which took place in Kigali Rwanda in June 2017.He is currently the head of the WHO Country Office in Rwanda.